Efficacy of a Streamlined Heart Failure Optimization Protocol (SHORT)
Heart Failure With Reduced Ejection Fraction, Chronic Heart Failure
About this trial
This is an interventional treatment trial for Heart Failure With Reduced Ejection Fraction focused on measuring Medication Sequencing, Optimization
Eligibility Criteria
Inclusion Criteria:
- Ejection fraction of less than 35%
- Increased NT-pro BNP levels > 600 pg per milliliter or ≥400 pg per milliliter if they had been hospitalized for heart failure within the previous 12 months.
Patients with atrial fibrillation or atrial flutter on baseline electrocardiography were required to have an NT-proBNP level of at least 900 pg per milliliter, regardless of their history of hospitalization for heart failure.
Exclusion Criteria:
1. Systolic BP of less than 100 mmHg on 2 consecutive measurements 2. eGFR less than 30 ml/min/1.73m2 3. Type 1 diabetes mellitus 4. Cognitive impairment that in the opinion of the investigator may lead the patient to be unable to understand and/or comply with the study medications, procedures and/or follow-up 5. Uncorrected primary valvular disease 6. Active malignancy treatment at time of visit 1 7. Women of child-bearing potential who are not willing to use a medically accepted method of contraception that is reliable in the judgement of the investigator 8. Women who are pregnant or breastfeeding
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Sites / Locations
- Queen Elizabeth Hospital King's Lynn
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Standard Arm
Streamlined protocol arm
Active Comparator: Standard Arm Both the current the European society of cardiology guidelines and National Institute of Health and Care Excellence currently advise that chronic stable heart failure patients with severely impaired left ventricular systolic function should initially be optimized as follows: Visit 1: ACEi/ARB and Low Betablocker commenced Visit 2: ACEi/ARB up-titrated; (Beta Blocker up-titrated) Visit 3: ACEi/ARB up-titrated; (Beta Blocker up-titrated) Visit 4: Switch ACEi/ARB to Entresto 100mg Visit 5: Modify Entresto dose to 200mg Visit 6: MRA Added Visit 7: MRA up-titrated Visit 8: SGLT2i started
Patients are optimized according to the accelerated protocol adapted from and based on the principles proposed by Prof McMurray and Prof Packer (Circulation 2021;143:875-877) Visit 1: Low Dose Beta Blocker started, SGLT2i started + Entresto 100 mg bd started Visit 2: MRA Added if renal function and potassium levels permit (Betablocker increased if BP and pulse rate permit) Visit 3: MRA up-titrated if BP and renal function and potassium levels permit (Betablocker increased if BP and pulse rate permit) Visit 4+: Betablocker increased if BP and pulse rate permit. Further visits may be required to facilitate a gentle up-titration of betablockers.